As many Canadians know, not every medical expense is covered by provincial plans. Most people have some kind of supplemental health insurance to cover extra costs. These include company group plans, where one becomes eligible by virtue of employment.
But what about those who don't have a group plan, and live with a pre-existing condition? Unlike with government plans, private insurers don't have to give anyone health coverage. They may decide a pre-existing condition is enough to turn down an application for a new policy.
The definition of pre-existing condition varies from insurer to insurer. How it may affect an insurance application also depends on the kind of coverage you need. The bottom line is to read the fine print and be honest. Failure to disclose a pre-existing condition will invalidate your coverage if you need to make a claim.
What is a Pre-existing Condition?
A pre-existing condition is something you had before you applied for insurance, from a cold to a life-threatening illness. A condition may be mild or serious -- but even those definitions are murky and differ between carriers. Most people think of pre-existing conditions as long-term health diagnoses, but they may also include pregnancy, substance use, or certain mental health challenges.
What Kinds of Conditions Exclude You from Coverage?
The length and type of coverage will affect the relevance of the pre-existing condition. For some short-term policies, like temporary travel medical insurance, your insurer may want to know if a medical condition is stable and controlled. So, if you have a heart condition that hasn't changed in the past six months, the company may approve your application. But if your doctor changed your medication two months before you are due to leave for your trip, the insurer may decide the condition is not stable and deny your policy.
When it comes to longer term coverage, a lot depends on the level of insurance you want and whether you are coming off of a group plan. If you are leaving your job or retiring, many private insurers give you the option to continue that plan as long as you opt in within a certain period of time, say two months. In these cases, you would pay the premiums previously paid by your employer. You typically wouldn't be subject to additional medical questions.
However, if you want more benefits or don't have group coverage, you may have to get a plan that is medically underwritten. A medically underwritten plan will require you to answer a series of health questions. Based on your medical history, the insurer will decide whether to sell you a policy. Some insurers tell applicants upfront that if they have any of a list of pre-existing conditions, they will be denied -- so there's no need to apply. Examples may include:
- AIDS
- Cancer within the last 10 years
- Congestive heart failure
- Drug or alcohol abuse within the last 5 years
- Heart attack
- Kidney disease
- Schizophrenia
However, this laundry list is just an example. It's not exhaustive, and may not apply to all insurers.
Tips to Get the Right Policy
In order to get the coverage you need, it's key to become proactive. First, if you know you'll be leaving a group plan, you may want to continue that coverage especially if you don't know if you can get new insurance. Second, shop around for policies from different insurers. Terms vary between carriers -- for example, one might consider a condition "stable and controlled" if there have been no changes within the past six months, while other insurers may only look at the past 90 days.
If you need ongoing health insurance, review as many policy options as possible. Different companies have different risk assessments. That means while some may not cover you if you have a certain condition, others may do so.
Review Your Options Online
The good news is you can start your research by heading to InsuranceHotline.com. There you can get the latest news and information about a wide variety of insurance products. Learn more about obtaining life insurance or travel insurance with a pre-existing condition.
